J Korean Ophthalmol Soc.  2015 Mar;56(3):345-350. 10.3341/jkos.2015.56.3.345.

Transscleral Fixation of Intraocular Lenses Using Modified Injector

• Lee SH
• Lee MJ
• Lim HW
• Seong MC
• Cho HY
• Kang MH

• KMID: 2339039
• DOI: http://doi.org/10.3341/jkos.2015.56.3.345

Abstract

PURPOSE
To evaluate the clinical stability and outcomes of 3-piece intraocular lens (IOL) transscleral fixation surgery using a modified injector.
METHODS
We have modified and used the Sapphire unfolder injector system (Allergan(R), USA). This involved, cutting a slit longitudinally at the terminal part of the injector so that a thread could pass through it freely. After a conjunctival peritomy created at 2 and 8 o'clock, a long curved needle with double-armed 10-0 polypropylene is passed through the exposed sclera. Two pieces of suture are withdrawn through the 2.8 mm corneal incision and 1 suture (from 8 o'clock) is passed through the opening of the cartridge and then tied to the leading haptic. Next, the IOL was implanted with the cartridge and then inserted through the corneal incision site. The other suture (from 2 o'clock) is tied to the haptic on the opposite side and inserted.
RESULTS
The study included 20 eyes of 20 patients with a mean age of 62.8 years at the initial visit. There were no complications, such as vitreous hemorrhage, retinal detachment, glaucoma, corneal edema, or iris injury. While the knot fixed to the leading haptic of IOL passed by the cartridge, there was no change of position. During the follow-up period, IOL dislocation did not occur and the corrected visual acuity and corneal astigmatism improved significantly.
CONCLUSIONS
This technique is an effective procedure for minimizing entangled thread and corneal astigmatism.

Keyword

Injector; IOL dislocation; Trans-scleral fixation

MeSH Terms

Aluminum Oxide
Astigmatism
Corneal Edema
Dislocations
Follow-Up Studies
Glaucoma
Humans
Iris
Lenses, Intraocular*
Needles
Polypropylenes
Retinal Detachment
Sclera
Sutures
Visual Acuity
Vitreous Hemorrhage
Aluminum Oxide
Polypropylenes

Figure

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  Figure 1. Modification of injector system: (Upper)-Injector before modification. (Lower)-After modification. Grinding between tip of injector and cartridge equip space was done.

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  Figure 2. The method of transscleral fixation using modified injector system. (A) The 10-0 polypropylene from the 7-o’clock posi-tion of the sclera is passed through the cartridge. (B) The thread is fixed to the leading haptic 2 mm away from the terminal end. (C) The cartridge is mounted on the injector. 10-0 polypropylene tied to the haptic is passed through the modified side groove of the injector. (D) Combined injector. 10-0 polypropylene is shown at the end of the injector.

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  Figure 3. Clinical outcomes of transscleral fixation using injector system. (A) Mean best corrected visual acuity (BCVA, log MAR), (B) SE (diopter) and (C) corneal astigmatism (diopter) of preoperative and posterative data. All clinical outcomes showed statistically significant differences after surgery ( p < 0.001, p = 0.004, p = 0.012). SE = spherical equivalent.

Reference

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